Hepatic Inflammation & Fibrosis-MR Elastography
Frank H. Miller1
1Northwestern University, Chicago, IL, United States

Synopsis

Hepatic inflammation and fibrosis are important causes of cirrhosis and hepatocellular carcinoma. The imaging findings of cirrhosis are often difficult to diagnosis on conventional imaging. MR elastography is the best method to assess for increased stiffness associated with fibrosis and inflammation. This talk will discuss the technique, interpretation and performance of MR elastography. Newer techniques including 3D MRE will be discussed. In addition, the patterns of findings on MR elastography will be discussed in relationship to different disease processes. Other causes of elevated stiffness will be demonstrated. Challenges such as iron overload will be discussed.

Chronic liver injury leads to inflammation and destruction of hepatocytes, and ultimately to parenchymal regeneration and fibrosis. Hepatic inflammation and fibrosis lead to cirrhosis and hepatocellular carcinoma (HCC). Liver fibrosis is the most important factor regarding the outcome in chronic liver disease, thus early treatment is associated with better outcomes, highlighting the importance of early detection and assessment of severity of hepatic fibrosi. Newer therapies can potentially reverse fibrosis. Furthermore, in small HCCs, the outcome of tumor resection is dependent on the status of the liver parenchyma and fibrosis. Therefore, it is also vital to accurately stage the degree of fibrosis in patients with chronic liver disease. Liver fibrosis can be diagnosed directly from an invasive liver biopsy or indirectly by surrogate markers for liver fibrosis.

MR elastography (MRE) is the best imaging method to assess increased stiffness associated with fibrosis and inflammation. This technique is becoming more widely used to evaluating hepatic fibrosis as a safer, and less expensive alternative to biopsy (reducing biopsy-related complications and sampling errors). MRE evaluates tissue stiffness by imaging mechanical shear wave propagation using motion-encoding gradients. Recently, there have been reports of MRE in differentiating benign and malignant liver lesions, HCC development, and post-hepatectomy failure but further validation is required. Proper interpretation of MRE stiffness requires careful review of the images and exclusion of confounding conditions that may alter liver stiffness.
This talk will:
1. Discuss the technique, interpretation and performance of MRE.
2. Discuss newer techniques including 3D MRE
3. Discuss the patterns of findings on MRE in relationship to different disease processes
4. Explore other causes of elevated stiffness
5. Discuss the challenges to MRE, such as iron overload

Acknowledgements

Dr. Richard Ehman

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Proc. Intl. Soc. Mag. Reson. Med. 29 (2021)